The leaves of Andrographis paniculata have been a part of Indian folk medicine and Ayurveda for centuries. The Chinese and Thai herbal medicine systems have also used this herb, mostly for its "bitter" properties, as a treatment for digestive problems and for a variety of fever-causing illnesses. More recently, this herb has become popular in Scandinavia as a remedy for upper lung infections and the flu.

The most widely tested product is called Kan Jang® (Swedish Herbal Institute). This product is available with andrographis alone and in combination with Eleutherococcus senticosus.

There is strong evidence from clinical trials to suggest that andrographis effectively reduces the severity and the duration of upper lung infections. According to early studies, andrographis may have a number of other potential therapeutic uses, including as an anti-inflammatory agent and as a treatment for chemically-induced liver damage. It has also been studied in human clinical trials for the flu and familial Mediterranean fever.

Serious side effects have not been seen; however, at higher doses toxicities may occur.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Research suggests that andrographis may reduce symptom severity and duration in active infections if started within 36-48 hours after symptoms develop. Additional studies are needed, especially those that test the effects of andrographis alone.

A

Early research has shown that andrographis has anti-inflammatory effects. This may play a role in the therapy of stomach and intestinal disorders that have inflammatory associations, such as ulcerative colitis. Clinical research has shown andrographis to have a positive clinical response that was significantly different than placebo; however, differences in clinical remission rates were lacking between groups. When compared to standard therapy, there was a lack of significant difference for symptom score reduction and for remission based on colonoscopy results. Further research is needed to determine if andrographis has a role in ulcerative colitis therapy.

B

Familial Mediterranean fever is a genetic disorder that mainly affects ethnic groups around the Mediterranean causing recurrent episodes of fever and swelling of serous membranes. While early studies suggest that a combination product containing andrographis may reduce the duration, frequency, and severity of attacks among children, more studies using andrographis alone are needed.

C

Early studies suggest that andrographis may reduce the duration and severity of flu symptoms, as well as the amount of sick time taken off from work by patients with the flu. More research is needed to confirm these results.

C

Early studies suggest that andrographis extract may help prevent URIs during the winter months if taken daily. Larger studies are required to confirm these results.

C

Early research has shown that andrographis has anti-inflammatory effects. This may offer a role in conditions that have inflammatory associations, such as rheumatoid arthritis (RA). The effects of an andrographis extract were evaluated in people with RA. Evidence of benefit was seen compared to baseline, however, there was a lack of significance when compared to placebo. Further research is therefore needed in order to establish a firm conclusion.

D

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Even though not well studied in clinical trials, typical amounts of leaf preparation are doses of 500-3,000 milligrams of andrographis leaf taken by mouth three times daily.

For rheumatoid arthritis, an extract containing 30 milligrams of andrographolides was given by mouth three times daily for 14 weeks with a lack of benefit compared to placebo.

For ulcerative colitis, 400 milligrams of an extract containing 8-10% andrographis by weight has been used three times daily for eight weeks. In addition, 1,200 or 1,800 milligrams of an andrographis extract has been taken by mouth daily in three divided doses for eight weeks.

For upper lung infection treatment, 3-6 grams (containing 48-500 milligrams of the andrographolides) divided into 3-4 daily doses, has been taken by mouth for 4-10 days. In addition, 100 milligrams KalmColdT (an extract) has been taken by mouth twice daily after dinner and breakfast for five days. A 1,200 milligrams Kan Jang® tablet has also been taken by mouth daily (duration unclear).

For upper lung infection prevention, 200 milligrams of andrographis has been taken by mouth daily as two Kan Jang® tablets for three months. Use appears to be safe for up to two weeks. Higher doses may be unsafe, leading to side effects.

Children (under 18 years old)

For upper lung infection treatment, 3-6 grams of andrographis, (containing 180-360 milligrams of andrographolides), divided into 3-4 daily doses, have been taken by mouth for seven days.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid with known allergy or sensitivity to products that contain andrographis or its parts.

Side Effects and Warnings

Andrographis is likely safe when used in doses containing up to 360 milligrams of standardized andrographolide extract daily in healthy people for up to two weeks or in lower doses (12 milligrams daily) for up to 12 weeks.

Andrographis is possibly safe in otherwise healthy children older than four years of age at doses up to 30 milligrams of standardized extract daily for 10 days.

Andrographis may increase the risk of bleeding. Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Andrographis may lower blood sugar levels. Caution is advised in people with diabetes or low blood sugar, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood sugar levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Andrographis may cause low blood pressure. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure.

Use cautiously with long term use due to insufficient data.

Use cautiously in people with skin disorders or those taking agents that increase risk of skin adverse events as andrographis has been reported to cause adverse skin reactions.

Avoid doses higher than 5 milligrams per kilogram daily of the andrographolide component, due to a risk of side effects.

Avoid in people with infertility or people actively trying to conceive due to animal studies suggesting that andrographis may have antifertility or contraceptive effects at high doses.

Avoid with known allergy or sensitivity to products that contain andrographis or its parts.

Pregnancy and Breastfeeding

Andrographis is not recommended during pregnancy due to possible contraceptive effects observed in animal studies. Safety during breastfeeding is unknown. In theory, andrographis may decrease sperm count.

Andrographis may increase the risk of bleeding. Use cautiously in patients taking anticoagulant agents, such as warfarin (Coumadin®) or heparin or with anti-platelet agents such as ibuprofen (Motrin®, Advil®) or clopidogrel (Plavix®). Andrographis use should be stopped before some surgeries; discuss this with a healthcare professional.

Andrographis may lower blood pressure and may therefore, add to the effects of drugs taken to lower blood pressure. Patients with high or low blood pressure who are considering taking any of these agents should discuss options with their healthcare professionals. Dosing adjustments may be necessary.

Andrographis may decrease blood sugar and may add to the effects of drugs taken to lower blood sugar, including insulin. Patients should be closely monitored by their healthcare professionals because dosing adjustments may be necessary.

Andrographis may also interact with agents for fever, agents for pain, agents for stomach acid, stomach and intestine disorders, and ulcers, agents for the skin, agents that affect nerves, allergy, anti-cancer, anti-inflammatory, antiviral, birth control, fertility, and immunomodulatory agents.

Interactions with Herbs and Dietary Supplements

Andrographis may increase the risk of bleeding. Use cautiously in patients taking anticoagulant agents. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

In theory, andrographis may lower blood pressure and may therefore, add to the effects of agents that also lower blood pressure. Patients with high or low blood pressure who are considering taking any of these agents should discuss options with their healthcare professionals.

Andrographis may lower blood sugar. Patients taking other herbs or supplements that may affect blood sugar levels, such as bitter melon (Momordica charantia), should be monitored closely by a healthcare professional while taking andrographis.

Andrographis may also interact with herbs and supplements for fever, for pain, for stomach acid, stomach and intestine disorders, and ulcers, herbs and supplements for the skin, herbs and supplements that affect nerves, anti-cancer, antihistamine, anti-inflammatory, antiviral, birth control, fertility, and immunomodulatory herbs and supplements.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.